Penile frenulum

Frenulum of prepuce
Details
SystemMale reproductive system
ArteryDorsal artery of the penis
VeinDorsal veins of the penis
NerveDorsal nerve of the penis
Identifiers
LatinFrenulum praeputii
TA98A09.4.01.012
TA23676
FMA19647
Anatomical terminology

The frenulum of the penis, often known simply as the frenulum (from Latin: frēnulum, lit. 'little bridle') or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa.[1][2] In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection.[3][4] In flaccid state it tightens to narrow the foreskin opening.[2]

The penile frenulum is similar to the lingual frenulum between the tongue's lower surface and the lower jaw, or the frenulum between the upper lip and the outside of the upper gum.[5]

In some men, the frenulum may appear shorter than normal, a phenomenon known as frenulum breve. Treatment of frenulum breve may be non surgical, or in other cases, especially with penile chordee, it may include frenulectomy or frenulum lengthening.[6][7]

Anatomy

The frenulum is a highly vascularized strip of mucosal tissue on the ventral side of the glans and the neck of the penis. It forms the interface between the outer and inner foreskin layers.[2] During gestation, it forms as the lateral edges of the preputial lamina approach in the ventral midline. The two sides of the lamina do not fuse in the midline but remain separated by a thin septum of mesenchyme that will create the preputial frenulum.[8] As part of the glans penis, the frenulum is innervated by divisions of the pudendal nerve; the dorsal nerve of the penis and a branch of the perineal nerve.[9][10] Blood supply to the frenulum is provided by branches of the dorsal artery of the penis that curve around each side of the neck to enter the frenulum and the glans from its ventral surface.[11] It is uncertain whether the frenular artery is single or paired.[12] Veinous drainage is thought to occur around the neck of the penis from smaller paired venules.[13] The frenulum occurs on the ventral midline of the glans, where the two glans wings merge forming the septum glandis.[14]

Research

The role of the frenulum in penile erection has been studied in cases of men with short frenula and premature ejaculation. Short frenulum may sometimes be associated with unsatisfied intercourse.[7] Treatment with lengthening or reconstruction of the frenulum in uncircumcised and circumcised men was reported to have positive results in satisfied intercourse, prolonged erection and time of ejaculation.[15][16]

For individuals with spinal cord injuries preventing sensations from reaching the brain, the frenulum just below the glans can be stimulated to produce orgasm and peri-ejaculatory response. It is often a way for those with spinal cord injuries to engage in sexual activities and subsequently feel pleasure.[17][18]

Clinical significance

Frenulum breve is a condition in which the frenulum is short and restricts the movement of the foreskin, which may or may not interfere with normal sexual activity. Frenulum breve may also contribute to frenular chordee, where the glans is pulled toward the vernal body of the penis. The condition can be treated with surgical and non surgical treatment. Non surgical treatment includes stretching exercises and steroid creams.[3] Surgical treatment includes frenuloplasty (frenulum lengthening or reconstruction), frenectomy, or circumcision.[4] There are a variety of different circumcision techniques in which the frenulum can be spared and left completely intact.[19]

It is possible for the frenulum to tear during sexual activities. This type of injury usually heals by itself.[20] In more severe cases, the frenular artery may be injured causing bleeding.

The frenulum may be entirely missing in cases of first degree hypospadias.

Frenectomy and frenuloplasty

As a treatment for frenulum breve or frenular chordee, a frenectomy or frenulectomy can be performed to excise the frenulum from the penis.[6] This is a form of genital frenectomy.[6] This procedure results in a smooth surface. A less invasive treatment which often retains the natural appearance and function of the frenulum to some degree is a frenuloplasty or frenulum lengthening. This procedure involves a (partial) incision of the frenulum and realigning the edges to gain more length. This makes the frenulum longer, effectively relieving pain and discomfort.[21][22]

See also

References

  1. ↑ Jensen C (2011). Can I Just Ask?. Hay House. p. 58. ISBN 9781848502468.
  2. 1 2 3 "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007. Archived (PDF) from the original on 2015-07-15. Retrieved 2009-06-12.
  3. 1 2 "Penis Frenulum: Location, Function & Conditions". Cleveland Clinic. Retrieved 2023-01-01.
  4. 1 2 "Short Frenulum - Frenulum Breve | Metromale Clinic & Fertility Center". 2020-01-21. Retrieved 2023-01-01.
  5. ↑ Iwanaga, Joe; Takeuchi, Naoshi; Oskouian, Rod J.; Tubbs, R. Shane (2017-06-29). "Clinical Anatomy of the Frenulum of the Oral Vestibule". Cureus. 9 (6): e1410. doi:10.7759/cureus.1410. ISSN 2168-8184. PMC 5574632. PMID 28856075.
  6. 1 2 3 Griffin AS, Kroovand RL (February 1990). "Frenular chordee: implications and treatment". Urology. 35 (2): 133–134. doi:10.1016/0090-4295(90)80060-Z. PMID 2305537.
  7. 1 2 "What should I do if my penis is torn?". nhs.uk. 2018-06-26. Retrieved 2023-01-01.
  8. ↑ Liu, Xin; Liu, Ge; Shen, Joel; Yue, Aaron; Isaacson, Dylan; Sinclair, Adriane; Cao, Mei; Liaw, Aron; Cunha, Gerald R.; Baskin, Laurence (2018-09-01). "Human glans and preputial development". Differentiation. Development of human male and female urogenital tracts. 103: 86–99. doi:10.1016/j.diff.2018.08.002. ISSN 0301-4681. PMC 6234068. PMID 30245194. As development proceeds the lateral ventral edges of the preputial lamina approach the ventral midline. The ventral edges of the preputial lamina do not fuse in the midline but remain separated by a thin septum of mesenchyme [...] destined to form the preputial frenulum.
  9. ↑ Yang, Claire C.; Bradley, William E. (1999-01-01). "Innervation of the human glans penis". Journal of Urology. 161 (1): 97–102. doi:10.1016/S0022-5347(01)62075-5. PMID 10037378. The dorsal nerve of the penis innervates the glans, including the frenulum which is also innervated by a branch of the perineal nerve.
  10. ↑ Weech, David; Ameer, Muhammad Atif; Ashurst, John V. (2022), "Anatomy, Abdomen and Pelvis, Penis Dorsal Nerve", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30247841, retrieved 2023-01-01
  11. ↑ Hinman, F. (1991). "The blood supply to preputial island flaps". The Journal of Urology. 145 (6): 1232–1235. doi:10.1016/s0022-5347(17)38584-1. ISSN 0022-5347. PMID 2033699. The blood supply to the frenulum arises from the dorsal artery of the penis. Branches of the dorsal artery curve around each side of the distal shaft to enter the glans and the frenulum ventrally.
  12. ↑ Gyftopoulos, Kostis I. (2018). "Meatal stenosis after surgical correction of short frenulum: Is the "pull-and-burn" method the way to go?". Urology Annals. 10 (4): 354–357. doi:10.4103/UA.UA_25_18. ISSN 0974-7796. PMC 6194789. PMID 30386085. It is unclear whether the frenular artery is single; in our experience, paired arteries were often evident, lying in the frenular bed
  13. ↑ Gyftopoulos, Kostis I. (2018). "Meatal stenosis after surgical correction of short frenulum: Is the "pull-and-burn" method the way to go?". Urology Annals. 10 (4): 354–357. doi:10.4103/UA.UA_25_18. ISSN 0974-7796. PMC 6194789. PMID 30386085.
  14. ↑ Özbey, Hüseyin; Kumbasar, Ali (2017). "Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications". Turkish Journal of Urology. 43 (4): 525–529. doi:10.5152/tud.2017.00334. ISSN 2149-3235. PMC 5687219. PMID 29201519.
  15. ↑ Song, B.; Cai, Z.-M. (2012). "Possible function of the frenulum of prepuce in penile erection". Andrologia. 44 (1): 23–25. doi:10.1111/j.1439-0272.2010.01099.x. ISSN 1439-0272. PMID 22126255. S2CID 32268548.
  16. ↑ Song, Bo; Hou, Zhen-hui; Liu, Qun-long; Qian, Wei-ping (2015). "[Penile frenulum lengthening for premature ejaculation]". Zhonghua Nan Ke Xue = National Journal of Andrology. 21 (2): 149–152. ISSN 1009-3591. PMID 25796689.
  17. ↑ Saulino MF (2006). "Rehabilitation of Persons With Spinal Cord Injuries". WebMD.
  18. ↑ Pryor JL, LeRoy SC, Nagel TC, Hensleigh HC (January 1995). "Vibratory stimulation for treatment of anejaculation in quadriplegic men". Archives of Physical Medicine and Rehabilitation. 76 (1): 59–64. doi:10.1016/S0003-9993(95)80044-1. PMID 7811177.
  19. ↑ Shenoy, S. P.; Marla, P. K.; Sharma, P.; Bhat, N.; Rao, A. R. (2015). "Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique". Journal of Clinical and Diagnostic Research. 9 (12): PC01–PC03. doi:10.7860/JCDR/2015/14972.6860. PMC 4717729. PMID 26816940.
  20. ↑ "Frenulum tear: Causes, first aid, and when to see a doctor". www.medicalnewstoday.com. 2020-05-29. Retrieved 2023-06-23.
  21. ↑ "Frenuloplasty | what is it and how is it performed?". Top Doctors. Retrieved 2023-06-23.
  22. ↑ "Lengthening of the penile frenulum (frenuloplasty)". Cambridge University Hospitals. Retrieved 2023-06-23.
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